What Can Help with Weakness and Also Shaking Hands?
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Q:  What Can Help with Weakness and Also Shaking Hands?

I am currently on 1200mg of Lithium and 375mg of Effexor and 150mg of Trazadone.  I am 6' 230 lbs and 35 yrs old.  I have been battling depression my whole life.  Recently I have have been feeling so tired and in a brain fog.  My hands shake all the time and it frustrates me because I am an artist and Arch.  I took Buspar and it does not stop the shaking.  I am not depressed and I have been sleeping but the weakness and the shaking of the hands are effecting me.  What can help with the shaking and weakness.

Thank you,

Dear Wade --

First, 2 basic steps:

 1.  Get your lithium level checked, if that has not been done recently.

2.  While you're at it, make sure that your thyroid is checked.  Make sure that it is not just "normal", but well over toward the "hyperthyroid" end of the normal range -- not near the "hypothyroid" end of the normal range (here is more about thyroid and bipolar if you need it to understand that recommendation or make the case to your psychiatrist).

If your lithium level is too high, that could cause shaking and weakness.  That's an easy one to fix.  Tremor is a very common side effect that higher doses.  However, make sure you don't just turn the dose down on your own.  You may have struck a delicate balance between Effexor and lithium, and shifting that balance without being prepared for dealing with the consequences would be a bad idea.

If your thyroid is too low, that too is easily detected and easy to fix.  This is less likely to be causing the tremor (I'm afraid that is pretty likely to be lithium) but it could be causing the brain fog and tiredness.

After that, it gets much trickier.  Those are standard potential explanations.  If neither of them is a satisfactory explanation, then something rather weird is going on.  As a friend of mine says, "medications are guilty until proven innocent, so if it's not lithium that is the problem, the spotlight rather necessarily turns on Effexor.  In my experience, antidepressants can be useful initially and then cause problems later, at the same dose and the same person.  So I would not exempt it, even though these are not typical side effects of Effexor.  (They might be atypical effects of having any antidepressant on board in the treatment of bipolar disorder, but that is another rather long story, and very controversial, and I have a particular point of view on it which is not standard amongst my colleagues.  For more on that point of view, see my lengthy story about Antidepressant Controversies.

I hope one of those ideas proves to be useful.  Good luck getting this figured out.

Dr. Phelps

Published June, 2009



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